ER physicians call foul over contract termination

After a sudden termination of their contract by Haywood Regional Medical Center last week, emergency room doctors say the reputation of hospital CEO David Rice is making it difficult to recruit new doctors to the county.

“This is not just about the emergency physicians. If he can breech a contract, what good is his word? Where does that leave any other physician in the community who has a contract with Rice?” said Mark Jaben, an ER doctor who is acting as the spokesman for the terminated group of Haywood Emergency Physicians. “The reputation about how the administration deals with physicians is out there. It is well known in the medical circles.”

Jaben said there is one way to repair that reputation, however.

“When the football team is playing bad the coach gets fired,” Jaben said.

“I have worked with a number of hospital administrations and this is among the best. I don’t feel the least bit threatened by them. I have found them nothing but supportive and helpful and interested in doing everything they could to make the hospital better,” Lang said.

This is not the first time Rice has had a falling out with a group of physicians. Two-and-a-half years ago, orthopedic care dried up after the lead orthopedic doctor and Rice butted heads. Haywood County was left with no orthopedists for several months, forcing patients with everything from a simple broken wrist to complex hip replacement to go elsewhere. Orthopedic services have yet to be fully restored in the county.

Six months after the orthopedic collapse, the hospital’s anesthesiologists resigned en masse after also butting heads with Rice. In both cases, Rice said he was protecting the interests of the entire hospital and could not bow to the sometimes mutually exclusive interests of individual doctors.

Lang said that Rice has always acted in the long-term best interest of the hospital. When his group was hired 12 years ago, they replaced a radiology team that was not doing a great job. The rest of the medical staff objected to the ousting the radiology team at the time, but in retrospect all agree it was the best move.

The same could be said of the ousting of anesthesiology team.

“You would not find a single person today who would want that old group back,” Lang said. “That may or may not be applicable to the current situation, but you have to look at the track record.”

Many in the medical community who are following the conflict appear to be siding with the ER doctors over the hospital administration. During a hospital wide meeting of doctors in November, they voted unanimously to take their concerns to the hospital board.

Doctors wanted to meet with the hospital board alone — without Rice present — to share their concerns. Rice was at the hospital wide meeting of doctors and told them the issue shouldn’t concern them. But the doctors disagreed.

Ultimately 45 doctors showed up for the meeting with the hospital board. But to their disappointment, only three of the eight board members were there. The other board members were instructed at the last minute not to come. If a majority of the board showed up, it would fall under the open meetings law and would be open to the public, including the press. So several members were told to stay away.

Stone walled

Jaben said the ER doctors did not have a fair opportunity to work with the hospital board on a resolution before the board voted last week to terminate their contract. The ER doctors had only one meeting with hospital administration and one meeting with the hospital board before the action was taken.

The nine-member hospital board voted 7 to 0 to terminate the doctors’ contract. One member was absent from the meeting and there is one vacancy on the board.

The ER doctors’ contract was terminated after the doctors refused to renegotiate the terms of their current contract.

“Our position was we don’t need to negotiate a new contract,” Jaben said. “We had a valid contract.” Their contract does not expire until May 2008.

But Rice had proposed a rewrite of the contract in late August. After weeks of a stalemate, six of the ER doctors — including Jaben — and their lawyer met with Rice and his lawyer to discuss the rewrite.

According to Jaben, Rice said the hospital had outstanding issues with the ER doctors, but would not enumerate them. Instead Rice wanted to focus solely on language in the new contract.

In November, the ER doctors appeared before the hospital board and asked them the same question: what issues do you have with our service that is prompting this rewrite?

“We got no response, stone cold silence,” Jaben said.

Jaben said he suspects Rice told the board not to speak, likely citing the potential of a lawsuit against the hospital by the ER doctors.

For the ER doctors, it was an impossible situation, Jaben said. Rice had never enumerated the alleged grievances against the ER doctors, and the board wouldn’t either.

“We asked over and over but they never articulated what the issues were,” Jaben said.

The ER doctors asked the board if the contract rewrite had anything to do with the quality of care provided by the ER doctors. Board members said that quality of care was not an issue prompting the rewrite, according to Jaben.

Jaben said the ER doctors were surprised this week when hospital administration enumerated specific grievances with the ER doctors to the media. Those issues had never been shared with the doctors themselves during the contract discussions, Jaben said.

“That’s the first time we heard most of those things,” Jaben said.

Dr. Nancy Freeman, a family practitioner and chairman of the hospital board, listed numerous grievances with the ER doctors in an interview. (See next week’s issue.) When asked whether those had ever been expressed to the doctors, she said the doctors chose to spend the majority of their time with the hospital board discussing their top hang-ups with the wording of the new contract.

Jaben said they didn’t know what else to talk about since the board wouldn’t speak to them, so they spent most of the meeting explaining why they didn’t like certain clauses in the proposed rewrite. Jaben said most of the issues cited to the media were not legitimate issues, but were attempts by the hospital administration to justification an unpopular decision.

“This was a sham negotiation never intended to reach any conclusion other than what’s happening,” Jaben said.

Uncooperative doctors

The hospital administration said the doctors were not willing to meet them even part-way.

“Even if they had put up something intermediate we would have kept the door open,” Freeman said. “We would have kept working. We just got ‘No, no, no. We don’t like that. We’re not going to agree.’ I think the board was receptive but basically the board was not getting what they needed in terms of these quality of performance issues.”

Freeman agreed that the board did not bring up these issues during their meeting with the doctors, but said the doctors could have addressed it.

“They had every opportunity to bring it up,” Freeman said. “I think they felt like they could step around those issues.”

Jaben asked how they could step around issues they didn’t even know existed.

Jaben said the board only made one comment that indicated why they had an issue with the ER doctors. During the meeting Freeman told the doctors their problem was their relationship with the hospital administration, according to Jaben.

In an interview, Freeman said quality of care by the ER doctors is good, but that the ER doctors have been generally uncooperative in hospital initiatives. ER doctors claim the hospital is using them as a scapegoat for insitutionl porblems.

Finding a new deal

At some point during negotiations with Haywood Emergency Physicians, hospital administration simultaneously began looking for other ER providers and found Phoenix, a corporate physician staffing company.

A contract with Phoenix would save the hospital money. Since the emergency room is required to treat patients that walk in the door regardless of their ability to pay, ER doctors get a high volume of poor patients that can’t pay

their bill. The hospital reimbursed the ER doctors for these patients, amounting to roughly $216,000 a year.

In reality, all doctors have patients that don’t pay. Those same ER patients also fail to pay radiology for their x-rays or anesthesiology for surgery. The hospital doesn’t reimburse those practices, however.

Phoenix wouldn’t expect indigent care reimbursement for its ER doctors, Rice said. Phoenix would want money for managing the team of doctors, however, namely $48,000 a year — twice what the hospital paid Haywood Emergency Physicians to manage their team of doctors. With reimbursement for poor patients out of the picture, however, the hospital would realize a total cost savings of $190,000 a year with the new group.

Jaben said the hospital never mentioned this issue with the doctors. Since they didn’t know about it, they were not given the chance to counter Phoenix’s offer, Jaben said.

Phoenix staffs 15 emergency departments. More than half of those are in Florida. They staff one in Dunn, N.C.

Chris Lutes, president of Phoenix, said he does not know how many doctors they will need to hire to serve Haywood Regional. Lutes said the company has a transition plan.

“We take the transition very seriously. It is a number one priority of this company,” Lutes said.

What they don’t have yet are enough doctors, which Lutes said they are currently working on. The doctors must already be licensed in the state of North Carolina since there’s not time for a doctor to get their license before the Dec. 28 transition date.

The Naturalist's Corner

This year will mark the 117th annual Audubon Christmas Bird Count (CBC.) The CBC is the longest-lived and largest citizen-science project in the world.

The count began in 1900. It was the brainchild of Frank Chapman, one of the officers of the fledgling Audubon Society. Chapman created the “bird census” as an alternative to the traditional Christmas “side-hunt,” a contest where groups would shoulder their arms and hit the fields and/or woods — the team that came back with the greatest number of corpses would be declared the winner.